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Estimating maternal health

New maternal mortality estimates spark surprise and caution in the Kingdom.

A NEW global study has reported a “dramatic” drop in the rate of women who die during pregnancy and childbirth in Cambodia, potentially providing cause for optimism among health experts who have long been frustrated by a perceived lack of progress with respect to the problem.

The study, published in the medical journal The Lancet last week, suggests that rather than remaining stagnant, maternal mortality rates (MMR) have fallen significantly both in Cambodia and worldwide. But it appears to contradict current widely used domestic estimates, which suggest the Kingdom has made little statistical progress on reaching a key Millennium Development Goal (MDG).

The authors of the study concluded that there were 266 deaths for every 100,000 live births in Cambodia in 2008, far lower than the accepted rate.
The 2008 national census estimated the MMR at 461 per 100,000, the third-highest in the region.

The findings come as a surprise to some experts, who say they are encouraged by the results but remain cautious with regard to their validity.
“If it is true, then this is great news for all of us,” said Chan Theary, executive director of the Reproductive and Child Health Alliance.

“But it is also hard to believe. If you look at the situation right now, a drop [in the maternal mortality rate] from greater than 400 down to 266 is very difficult to believe. But let us study it.”

Though the study suggests progress has been made in reaching Cambodia’s original MDG for maternal mortality of 140 deaths per 100,000 live births by 2015, evidence on the ground shows that more work remains, Chan Theary said.

“Accessing healthcare is the biggest problem,” she said. “Two weeks ago I was in Pursat province. If you look at the situation there, it is very difficult. It was a mountainous, very remote area. They only had one temporary midwife at a care centre working [in one area]. She had very little practical experience.”

Government officials are also striking a cautious tone in response to the study.

“We would be happy if this statistic is true, but actually, I think we have not yet reached this rate,” said Paou Linar, head of child and maternal healthcare at the Phnom Penh Health Department.

For now, officials do not plan on adjusting Cambodia’s MMR unless the study’s findings are first corroborated by institutions like the World Health Organisation (WHO), he said.

“The reason why the Ministry of Health still accepts this rate is because we want to urge officials to pay attention to work hard and carefully on this issue,” he said.

“If we see that there are suddenly very positive statistics, maybe they can become a bit careless.”

Globally, the study suggested, overall maternal death estimates were significantly lower than previous counts.

Though researchers acknowledged wide uncertainty intervals in the numbers, they estimated that maternal deaths had fallen from 526,300 in 1980 to 342,900 in 2008.

By comparison, the prevailing global figure was pegged at 536,000 deaths in 2005, an estimate developed by UN institutions including the WHO.

The new study, which was conducted by researchers at the University of Washington and the University of Queensland, used more accurate figures and newer methods than previous estimates, according to Lancet editor Richard Horton.

In a commentary released with the study, Horton said he expects the results to provoke “intense debate”. The Lancet was asked to delay publishing over fears the findings could damage advocacy efforts and cause confusion, he said.

Despite the controversy, Horton said, the study’s findings should be grounds for optimism, not argument; the research shows that strides have been made in reducing maternal deaths, which were long considered “a source of puzzlement and embarrassment” to health leaders because of a perceived “lack of progress”, he said.

“The latest figures are, globally, good news. They provide robust reason for optimism,” Horton said. “More importantly, these numbers should now act as a catalyst, not a brake, for accelerated action on [MDG targets for maternal health], including scaled-up resource commitments.”

Last year, Ministry of Health officials requested that Cambodia’s MDG for maternal mortality be revised upward, saying that the existing MMR target of 140 had been put out of reach by the global financial crisis.

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